ABSTRACT
Chronic otitis media can be defined as chronic inflammation of the middle ear cleft including mucosa, tympanic membrane and ossicles. It can be subdivided into non-suppurative and suppurative (Table 44.1). Chronic non-suppurative otitis media is better known as otitis media with effusion (OME) and commonly referred to as glue ear. Chronic suppurative otitis media (CSOM) has attracted a variety of subclassifications, which has caused confusion with similar terminology not always referring to the same clinical entity. The terms tubo-tympanic and attico-antral were intended to differentiate between ‘safe’ (central perforation) and ‘unsafe’ (marginal perforation) disease, respectively. The former was associated with or without persistent or intermittent discharge, and the latter associated with squamous epithelium ingrowth, i.e. cholesteatoma. While these terms were generally helpful to define the clinical picture in the majority of cases, they are not universally accurate and have fallen into disrepute. A more helpful classification of CSOM would be as follows: non-cholesteatoma ears (with the presence of either a perforation or a retraction
pocket) or cholesteatoma cases with ingrowth of keratin-producing epithelium whether this is via an attic perforation or in a pars tensa perforation or retraction.
